Provider Demographics
NPI:1811954936
Name:RODGERS, MARK ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:707 N FIELDER RD
Mailing Address - Street 2:#A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-277-2671
Mailing Address - Fax:817-460-3004
Practice Address - Street 1:707 N FIELDER RD
Practice Address - Street 2:#A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-277-2671
Practice Address - Fax:817-460-3004
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8122J1OtherBC/BS
D67654Medicare UPIN
TX8122J1Medicare PIN